tbuckley/cabot-search huggingface dataset:
Obesity and toxic habits as avoidable determinants of chronic peripheral neuropathy induced by chemotherapy (NPCIQ): NeuroPredict project.
Authors: Alicia Vargas, María José Contreras, María De la Haba, Maria Teresa Cano, Cristina Morales-Estevez, Ignacio Porras, Gema Pulido, Pablo Flores Paco, Juan De La Haba, Enrique Aranda
Journal: Journal of Clinical Oncology (2023)

e24097 Background: Anti-tumor therapy is the most frequent cause of toxic neuropathy in the Western population. Unlike its acute presentation (AN), chronic neuropathy appears during treatment and persists for more than six months after the end of chemotherapy, significantly limiting the quality of life of many patients. Although it is a drug-dependent toxicity, there is scarce evidence about its frequency and the factors that are determinant in its development. The main objetive is to know the incidence of NPCIQ as well as to identify factors that predispose to its appearance. Methods: We retrospectively selected 98 patients treated with adjuvant chemotherapy with paclitaxel (P) (80mg/m2/weekly) or oxaliplatin (O) (130 mg/m2/every 3 weeks), establishing three groups: Group A and B: Patients treated with P or O and who have developed NPCIQ and Group C patients treated with P or O and who have not developed NPCIQ.Group A P+ NPCIQ: 34 (33,3 %), Group B O+NPCIQ: 27 (26,5 %) and Group C non-NPCIQ: 37 (36,2%). Results: Of the 79 patients who developed AN, 61 (77,2%) developed NPCIQ, of these 34 due to paclitaxel and 27 due to oxaliplatin. Those patients with a body mass index &gt; 30 or toxic habits developed NPCIQ more frequently: 24% vs 36% and 24% vs 42% (p: 0.054) respectively (Table 1).The obesity impact on NPCIQ is statistically significative for paclitaxel group (p: 0,027). Conclusions: NPCIQ is a frequent toxicity, there are avoidable factors such as obesity, smoking and alcohol that can influence its development. Recommendations aimed at avoiding overweight or the consumption of alcohol and tobacco may be useful to reduce the incidence of NPCIQ. [Table: see text]
Adherence to mercaptopurine (6-MP) and habit strength in pediatric acute lymphoblastic leukemia (ALL).
Authors: Mira Yang, Sherif Mohamed Badawy, Revika Singh, Kathryn King
Journal: Journal of Clinical Oncology (2023)

10030 Background: Rates of adherence to mercaptopurine (6-MP) below 90% have been associated with increased relapse in pediatric patients with acute lymphoblastic leukemia (ALL). Habit strength has been associated with medication adherence through multiple mechanisms, including self-efficacy and social norms. The goal of this study was to investigate the relationship between habit strength, adherence to 6-MP, and health-related quality of life domains. Methods: This was a single center, cross-sectional study. A total of 52 participants, including 11 patients (ages 12-23, mean age 16 ± 4, 45% Female) and 41 parents/caregivers (ages 25-43, mean age 37 ± 5, 80% Female) of patients with ALL under the age of 18. Participants completed the Visual Analogue Scale (VASdose), PROMIS Medication Adherence Scale (PMAS), Self-Regulated Habit Index (SRHI), and PROMIS quality of life measures (PROMIS-CAT). Spearman’s rho correlations were used to assess relationships between variables. Eleven semi-structured interviews of patients and caregivers were conducted and analyzed using Grounded Theory coding and thematic analysis. Results: Overall, 81% (n = 42/52) of participants surveyed had high adherence to 6-MP (VASdose ≥95%); 91% (n = 10/11) of patients and 78% (n = 32/41 of parents/caregivers reported high adherence. The median VASdose and PMAS score were 100% (IQR 97-100) and 39.5 (IQR 38-40) across all participants, respectively. Participants with higher adherence, VASdose ≥ 95% and PMAS ≥ 39.5, reported less physiological stress (p = 0.02), and better cognitive function (p = 0.09) and peer relations (p = 0.08), compared to those with lower adherence. No significant correlation was found between medication adherence rate and habit strength. Emerging themes from qualitative coding included the influence of routine and automaticity on 6-MP as well as adherence strategies. Strategies such as reminders, care team communication, and developing personalized tools were cited by participants as potentially improving adherence in taking or administering 6-MP. Other facilitating participant characteristics included experience with medication administration, self-efficacy, and access to social support. Financial burden, scheduling conflicts, and medication access were common barriers cited by participants. Conclusions: Nearly one-fifth of our participants reported lower adherence to 6-MP (VASdose &lt; 95%), which increases risk of relapse. Medication adherence to 6-MP was not associated with habit strength, but our results show preliminary associations between adherence rates and quality of life outcomes, such as physiological stress. Behavioral interventions are needed to better optimize adherence to 6-MP and improve health outcomes in pediatric ALL.
Breast cancer brain metastases: The graded prognostic assessment index (GPA) in a real-world low- and middle-income (LMIC) population.
Authors: Giselle de Souza Carvalho, Giullia Bortolini de Lucena, Isabele Avila Small, Jose Bines
Journal: Journal of Clinical Oncology (2023)

e18531 Background: Up to 15% of breast cancer patients develop brain metastases during the course of their disease. Graded Prognostic Assessment (GPA) estimates survival for patients with brain metastases. This retrospective analysis assesses the applicability of the GPA and highlights the outcomes for patients from a Low- and Middle-income Country (LMIC). We compared the GPA-predicted survival for each patient with the actual overall survival. Methods: A single-center retrospective analysis of patients identified from the neurosurgery, radiation therapy and palliative care databases of the Instituto Nacional de Câncer (INCA), Brazil, from October 2018 to June 2020. Survival analyzes were performed using the Kaplan-Meier method and the curves were compared by the Log-rank test. Results: We identified 110 patients with breast cancer brain metastasis and 84 patients were followed through December 2021. 10 patients were still alive at the end of follow-up. Median age at breast cancer diagnosis was 48 years, and median time from breast cancer diagnosis to brain metastases diagnosis was 30.6 months. 62% were premenopausal and ECOG-PS was 0 - 1 in 44%, and 2 in 25% of patients. 94% of tumors were of ductal histology, 43% hormone receptor (HR) +/HER2 - disease, 30% triple-negative, and 27% HER2 + (17% HR+ and 10% HR-). 22% stage IV disease at diagnosis. The median time from breast cancer diagnosis to brain metastases was 30.6 months (range, 0.3 to 232 months). 95% of patients were symptomatic at the time of the brain imaging, mainly headache and focal neurological deficit. 64% of patients had less than three brain metastases. Patients underwent neurosurgery (71%), stereotactic radiosurgery (13%) and WBRT (38%), and the median time from brain metastases diagnosis to local treatment was 18, 20 and 10 days, respectively. Median time from brain metastases to death was 5.5 months, being 4.0 months for HR+HER2-, 4.5 months for triple-negative, and 12.0 months for HER2+ disease (p = 0.18). The median time calculated according to the GPA for the whole patient population was 13 months. Conclusions: Breast cancer patients with brain metastases had a shorter median survival time than the one estimated by the GPA. We hypothesize that a delay between CNS symptoms and brain imaging may explain this worse outcome. The prognostic score is an important tool to assist in choosing therapeutic options. It can also highlight health disparities and consequently stimulate the search for potential strategies to improve patients outcomes.
The role of Chinese acupuncture plus herbal decoction for chemotherapy induced cognitive impairment in elderly cancer patients.
Authors: Guangmei Lv, Meng Hu, Wei Liang, Haijun Wan Wan, Sunyan Zhao, Wentao Ha, Yongling Gong
Journal: Journal of Clinical Oncology (2023)

e24018 Background: Elderly cancer patients would suffer cognitive impairment due to chemotherapy, and a series of neurocognitive symptoms, known as "chemobrain". Chinese acupuncture plus herbal decoction is an emerging therapeutic option for chemotherapy-induced cognitive impairment in elderly cancer patients, despite limited supporting evidence. By evaluating this novel Chinese medicine mode in elderly cancer patients at our institution, we aimed to contribute to the existing knowledge in this area while establishing a basis for further research. Methods: We performed a retrospective review of all cases of “chemobrain” related elderly cancer patients treated with Chinese acupuncture plus herbal decoction between 2019 and 2022. We identified 168 elderly cancer patients with clinically confirmed chemobrain; 83 were treated with electroacupuncture (2 sessions per week over 8 weeks) plus herbal decoction(Chines herbal medicine); 85 received either conventional drug therapy, or palliative-intent therapy. The Montreal Cognitive Assessment(MoCA) served as the primary outcome. Digit span test was the secondary outcome for attentional function and working memory. The quality of life and multiple functional assessments were also evaluated. Results: Those with Chinese acupuncture plus herbal decoction had much better performance than the remainder(as control), reverse digit span test at Week2 and Week8, with medium eﬀect size of 0.53 and 0.48, respectively, the difference in MoCA score and prevalence of chemobrain between cohorts was underpowered and not statistically significant. Higher baseline ECOG and comorbidity was noted in the latter cohort. Conclusions: These results suggest that Chinese electroacupuncture plus herbal decoction might have particular beneﬁts in reducing chemotherapy-induced working memory impairment and could markedly reduce various side effects caused by cytotoxic chemotherapy drugs.
Healthy lifestyle behaviors among a diverse population of early posttreatment adolescent and young adult (AYA) survivors participating in a virtual stress management program.
Authors: Vinayak Venkataraman, Michaela Markwart, Lucy Finkelstein-Fox, Jennifer S. Temel, Elyse R. Park, Giselle Katiria Perez
Journal: Journal of Clinical Oncology (2023)

e24048 Background: Adolescent and young adults (AYA) cancer survivors have worse long-term physical health than survivors of adult cancers. Healthy lifestyle behaviors can maximize physical health and enhance quality of life. The National Comprehensive Cancer Network (NCCN) publishes survivorship guidelines for healthy behaviors; however, it is unclear if AYA survivors follow these recommendations. Methods: This is a secondary analysis of a waitlist-controlled trial of an adapted mind body stress management group program for AYA survivors recruited between 03/2019-09/2020. Participants completed self-report questionnaires assessing tobacco use, e-cigarette use, alcohol use, physical activity, and sleep quality both before and after completing the 8-week group program. Descriptive statistics were used to characterize the proportions of survivors meeting NCCN guidelines at time of enrollment. Results: Seventy-two AYA survivors participated in this study (mean age 24, 74% female, 60% Non-Hispanic White, 21% Hispanic, 4% Black, 53% hematologic malignancy, mean 1.6 years post-treatment).Table 1 summarizes NCCN guidelines and concordant behavior at enrollment. Most participants met guidelines for tobacco and e-cigarette use at study entry, with the majority reporting they abstained from using tobacco (85%) and e-cigarettes (90%). Only 28% reported abstaining from any alcohol use. Of those who consumed alcohol, most reported consuming &lt; 3 drinks per day (83%), but 65% endorsed at least occasional binge drinking behavior ( &gt; 5 drinks). Only 52% met guidelines for vigorous- or moderate- intensity activity (i.e. 75 and 150 minutes weekly, respectively). Specifically, participants reported a median of 47.5 minutes/week (IQR 0-120 min/week) of vigorous-intensity activity and 60 minutes/week (IQR 30-140) of moderate-intensity activity. Many experienced sleep concerns, with only 30% reporting good or very good sleep (i.e. &gt; 4 on a 1 (very poor)-5 (very good) Likert scale). Conclusions: In a racially/ethnically diverse sample of AYA survivors, NCCN survivorship guideline concordance for healthy lifestyle was mixed. Of concern was that AYA survivors’ use of tobacco and e-cigs was similar to the general population. Furthermore, alcohol and physical activity recommendations were mostly not followed, and reported sleep quality was poor. These results highlight the need to better understand barriers and promote healthy lifestyles to optimize post-treatment outcomes. [Table: see text]
Impact of imaging frequency on progression free survival in Alliance clinical trials enrolling patients with untreated follicular lymphoma.
Authors: Sarah C. Rutherford, Jun Yin, Levi D Pederson, Kristie A. Blum, Peter Martin, Sin-Ho Jung, Barbara Grant, Cara Rosenbaum, Bruce D. Cheson, Nancy L. Bartlett, Sumithra J. Mandrekar, John Paul Leonard
Journal: Journal of Clinical Oncology (2023)

7520 Background: With goal of simplifying clinical trials in lymphomas, we reported that bone marrow biopsies are irrelevant for response assessment in most patients (pts) with follicular lymphoma (FL) on trials (Rutherford JCO 2023). We then investigated impact of imaging frequency in FL clinical trials. We hypothesized that progression free survival (PFS) would not be different when imaging is performed less frequently than required by trials. Methods: We identified all trials through Alliance for Clinical Trials in Oncology that enrolled untreated pts with FL from 2008-2016. We considered 2 imaging schedules: protocol specified (control) vs relaxed (X) in which response assessments at every other required time point were omitted. For each trial, we estimated PFS using Kaplan Meier methods for the 2 schedules then determined difference in PFS between schedules as % change from control schedule in 2 year (yr) PFS rate. We performed simulation studies to approximate impact of less frequent imaging on PFS estimation using 50901 (low-intermediate risk FL) and 50904 (intermediate-high risk FL, control arm). We assumed exponential distribution for PFS, where rate parameter was calculated based on observed median PFS with uniform censoring distribution. Protocols for 50901 and 50904 mandated imaging every 4 months (mos) for 2 yrs then every 6 mos (S0). We ran 1000 iterations of 100 observations using 3 tumor assessment follow up schedules: every 6 mos for 2 yrs then yearly (S1), every 8 mos for 2 yrs then yearly (S2), or yearly (S3) for simulated progression times. We calculated deviation of PFS using simulated schedules from truth (S0). Results: Across 5 FL trials, median percent change of schedule X from control schedule in estimated 2yr PFS was 2.1% (0.0-30.8%) and in estimated 4yr PFS was 0.9% (-8.6-25.7%). Disparate result in 50901 is due to small shift in events with low number of pts at risk for progression. Simulation study results by trial were: for 50901, true median PFS 1.9 yrs and average median PFS for S1, S2, and S3 of 2.05, 2.11, and 2.21 yrs; for 50904 (control arm), true median PFS 4.1 yrs and average median PFS for S1, S2, and S3 of 4.16, 4.12, and 4.05 yrs. Conclusions: Our findings support decreased frequency of imaging studies in FL clinical trials, which would improve resource use and decrease pt burden. We plan a larger analysis to confirm results. https://acknowledgments.alliancefound.org . Clinical trial information: NCT00553501 , NCT01145495 , NCT01190449 , NCT01286272 , NCT01829568 .[Table: see text]
MSI analysis in patients with GIST with lynch syndrome.
Authors: Silvia Gasperoni, Luca Messerini, Francesca Castiglione, Laura Papi, Francesca Gensini, Fabio Cianchi, Antonio Taddei, Paolo Prosperi, Federico Perna, Francesco Coratti, Lorenzo Antonuzzo
Journal: Journal of Clinical Oncology (2023)

e23510 Background: Lynch Syndrome due to mutations in one of DNA mismatch repair (MMR) genes, is found in patients with colon cancer (3%).The mutations in these DNA repair genes induce genetic instability and development of ovarian, endometrial, urothelial, gastrointestinal and biliary tract carcinoma. Methods: In our center, 31 patients with Lynch syndrome are followed in Oncology Department in multidisciplinary team according to regional diagnostic therapeutic assistance paths and international guidelines. Immunohistochemical staining (IC) for mismatch repair proteins (MLH1, MSH2, MSH6, PMS2) and microsatellite instability testing (MSI) by PCR real time easyPGX were performed in colon cancer, genetic testing has been preceded by genetic counseling. When GIST diagnosis occurred in patients with colon cancers and Lynch syndrome, IC and MSI were performed in GIST too. Results: MSI-H has been detected in synchronous colo-rectal cancer in 2 patients with GIST. Pathogenetic germline mutations in MSH2 gene were observed in both patients. In 1 female patient with gist of duodenum (very low risk according to Miettinen classification) with previous endometrial cancer and sincronous PT3N0 rectal cancer, we observed MSI-stable in IC and PCR, KIT/PDGFRα wild type in Next GenSequencing analysis, BRAF wild type (PCR-real time), SDH-B + (IC), NTRK 1 (exon 9-10, exon 1-12 del, exon 12), NTRK 2 (exon 12-15.exon 16-17), exon 14, NTRK 3 (exon 14, exon 15) no gene fusion by PCR-real time (CE.IVD kit easy NTRK). In 1 male patient with ileal GIST (intermediate risk according to Miettinen classification ) with ileal adenocarcinoma pT3N0, we observed KIT exon 11 mutated, MSI-stable in IC, when we repeated the analysis using PCR real time EasyPGX, we observed high instability of microsatellites. Conclusions: For the first time we observed in Lynch Syndrome MSH2 mutated, simolutaneous GIST and colon cancer in the same site of ileum and PCR analisys detected a rare exemple of microsatellite instability in GIST.
An epidemiological profile of colorectal cancer patients diagnosed at a single cancer center in Costa Rica from 2018 to 2022.
Authors: Esteban Garita, Andres Wiernik, Catalina Ulloa, Fernando Brenes, Luis Diego Flores, Eduardo Alfaro
Journal: Journal of Clinical Oncology (2023)

e22523 Background: According to the International Agency for Research on Cancer, in 2020 there were 1,257 patients diagnosed with colorectal cancer (CRC) in Costa Rica. Despite Costa Rica having universal health coverage, approximately 20% of patients seek care outside of the public system. This growing population may be overlooked when creating registries or research. The aim of this study is to present a five-year epidemiological profile of patients with CRC diagnosed by the only private cancer center in Costa Rica: Centro de Cáncer y Hematología del Hospital Metropolitano. Methods: A retrospective review of all the patients with biopsy proven CRC diagnosis from January 2018 until November 2022 at the center was completed. Data was extracted from pathology database that included both endoscopic and surgical samples. Variables of interest included year of diagnosis, gender, age, pathological staging, and tumor site. Variables were analyzed by descriptive statistics. Results: A total of 253 patients (n = 253) were identified. When stratified by year, there were 16 patients (6.3%) diagnosed in 2018, 59 (23.3%) in 2020, and 67 (26.5%) in 2022. There were 129 female patients (51.0%) and 124 male patients (49.0%). Age was normally distributed with a mean of 65 ± 14 years and a range of 29-92. 33 patients (13.0%) were younger than 50 years old, from which 19 (7.5%) were male and 14 (5.5%) female. According to staging, 46 patients (18.2%) had localized disease, 34 (13.4%) had regional disease, and 12 (4.7%) had distant. 161 patients (63.6%) were categorized as unknown since the staging was not available. As per tumor location, 68 samples (26.9%) were right sided tumors, which included cecum and ascending colon; 13 samples (5.1%) were transverse; 89 samples (35.2%) were left colon, including descending and sigmoid colon; and 65 samples (25.7%) were from rectum. 18 samples (7.1%) were categorized as unknown. Conclusions: This study complements existing literature regarding CRC epidemiology and contributes to the emerging research being done by developing countries in Central America. The results match international trends and they suggest a yearly growth of patients being diagnosed outside of the national public system. Additionally, real-world data like this is necessary when considering screening guidelines for CRC by national authorities. Future directions are to follow the cohort for an eventual five-year mortality study, include molecular tests to build a genetic profile, and pursue a collaboration with Costa Rican public centers to determine the disease’s behavior in a national scope.
Outcomes of patients with a myeloproliferative neoplasm and atrial fibrillation.
Authors: Orly Leiva, Chi-Joan How, Andrew Brunner, Jeremy Grevet, Gabriela Hobbs
Journal: Journal of Clinical Oncology (2023)

7070 Background: Patients with myeloproliferative neoplasms (MPN), including essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF), are associated with increased risk of cardiovascular (CV) disease including arterial thrombosis (AT). Atrial fibrillation (AF) is also associated with increased risk of AT and often co-exists with MPN. However, thrombotic and bleeding outcomes in patients with MPN compared with those without have not been thoroughly investigated. Methods: Patients aged ≥ 18 years with a hospital admission for AF with and without a history of MPN in 2017 and 2018 were identified using the National Readmission Database. Primary outcomes were 30-day (D) and 90-D any-cause, AT-related (including stroke, myocardial infarction, arterial thromboembolism), and bleeding-related readmissions. Propensity score weighting (PSW) was performed in order to adjust for imbalances between MPN and non-MPN patients. PSW Cox proportional hazards was performed to estimate risk of 90-D readmission in patients with MPN compared with patients without. Results: A total of 468,094 patients with AF were identified with 1,617 patients having a history of MPN. CHA 2 DS 2 -VASC (mean 3.8 vs 3.7) and HAS-BLED scores (mean 2.4 vs 2.3), risk scores for AT and bleeding in AF, were similar between MPN and non-MPN patients. After PSW Cox proportional hazards, patients with MPN had an increased risk of 30-D all-cause (HR 1.72, 95% CI 1.70 – 1.74), AT (HR 1.45, 95% CI 1.38 – 1.53), and bleeding (HR 2.21, 95% CI 2.01 – 2.44) re-admissions. MPN patients had an increased risk of 90-day any cause (HR 1.38, 95% CI 1.37 – 1.40) and bleeding (HR 1.76, 95% CI 1.65 – 1.88) but not AT (HR 1.03, 95% CI 0.99 – 1.08) readmissions. Conclusions: Among patients admitted for AF, MPN is associated with increased risk of 30-D and 90-D any-cause and bleeding readmissions and 30-D AT readmissions despite similar CHA 2 DS 2 -VASC and HAS-BLED risk scores. Further studies are needed to identify risk factors for bleeding and AT in patients with MPN and AF and improve on current risk scores, which do not include MPN status. [Table: see text]